Main Menu

Assessment of an enhanced program for depression management in primary care: cluster randomised controlled trial

Condition category

Mental and Behavioural Disorders

Date applied

19/01/2007

Date assigned

02/02/2007

Last edited

25/08/2015

Prospective/Retrospective

Prospectively registered

Overall trial status

Completed

Recruitment status

No longer recruiting

Plain English Summary

Background and study aimsWe put into place a new programme based on the chronic care model to improve the management of depression in primary care and compared its effectiveness with the usual care. The goal of the study was assessed the effectiveness of the new programme in terms of the severity of depression, response to treatment, remission of depression and quality of life related to health. We invite the reader to watch an informative video http://vimeo.com/34126848 and to visit our web page www.projecteindi.cat

Who can participate?Participants were 338 adult patients, age 18 years or over, from 20 primary care centres of the Catalan Health System in Spain, with diagnostic criteria for major depressive episode according to DSM-IV, who had not taken antidepressants in the last three months and were willing to take antidepressants.

What does the study involve?Over a period of two years, we recruited 149 patients into the control group (usual care) and 189 in the intervention group (new programme). We compared the effectiveness of the two treatments. The treatment in the new programme involved clinical, educational and organisational procedures including primary care nurses who worked as care-managers. Outcomes were measured at 0, 3, 6 and 12 months.

What are the possible benefits and risks of participating?The study confirmed that the new programme was more effective than the usual care and showed an improvement of the clinical outcomes of depression in the short (3 and 6 months) and long terms (12 months).

Where is the study run from?20 primary care centres of the Catalan Health System in the province of Tarragona in Spain.

When is the study starting and how long is it expected to run for?Recruitment of patients took two years, from June 2007 to June 2009. Results were analysed one year after the recruitment of the last patient in June 2010.

Who is funding the study?Carlos III Health Institute of the Spanish Ministry of Health and Consumption (Fondo de Investigaciones Sanitarias- Instituto de Salud Carlos III - Ministerio de Sanidad y Consumo) and the Catalan Institute of Health (Institut Català de la Salut), Spain.

Who is the main contact?Dr Enric Aragonès earagones.tarte.ics@gencat.cat

Study design

Primary study design

Secondary study design

Trial setting

Trial type

Treatment

Patient information sheet

Condition

Moderate to severe, or mild persistent, episode of Major Depression (DSM-IV) who initiate a new antidepressant treatment episode.

Intervention

Two groups, one of which is a control group comprising patients receiving usual primary care management and the other is the intervention group comprising patients on a structured programme for treating depression.

Intervention group:Implementation of a multicomponent programme for managing depression. It includes training for the general practitioners (eight hours workshop and periodical follow-ups) and availability of evidence-based clinical guidelines based on the National Institute for Health and Clinical Excellence (NICE) depression guideline. It also includes care managers, role developed by staff primary care nurses trained to provide educational and emotional support for the patients, to promote treatment adherence and to provide active and systematic clinical monitoring. The program establishes a minimal number of structured visits: in the acute phase, one week after the incorporation and later monthly up to obtaining the remission; in the continuation phase will be every two months; nevertheless, the plan of follow-up visits will be individualised. The optimal supervision and consultation mechanisms will be implemented with the psychiatric level.

Control group:Usual primary care management.

Intervention type

Other

Phase

Not Applicable

Drug names

Primary outcome measure

1. Severity of the depressive symptoms at three, six and 12 months2. Response rate at three, six and 12 months3. Remission rate (Patient Health Questionnaire [PHQ-9]) at three, six and 12 months

Secondary outcome measures

Overall trial start date

01/01/2007

Overall trial end date

31/12/2009

Reason abandoned (if study stopped)

Eligibility

Participant inclusion criteria

1. Primary care patients over 18 years of age 2. An episode of major depression (Diagnostic and Statistical Manual of mental disorders - fourth edition [DSM-IV]), moderate to severe, or persistently mild3. Who need to initiate anti-depressant treatment